Abstract

We are entering a new era in the approach to the question always asked about the patient with puzzling jaundice: is it medical or surgical? In past years the answer has often been sought in laparotomy, in spite of the fact that anesthesia and surgery often are poorly tolerated in patients with hepatocellular disease. Those who favored early surgery for diagnosis pointed to the prolonged period of expensive hospitalization often required to establish a diagnosis with noninvasive methods and to the risk of cholangitis and biliary cirrhosis with untreated bile duct obstruction. Liver biopsy, isotope scanning, hypotonic duodenography, celiac angiography,